Your Digest for Thursday, Aug 22, 2024 11:59 PM


Posterior myocardial infarction (MI)

#2021GM-JUL/Q21

Which part of the heart is 'posterior'?

Source
This article confirms that there is some confusion about which part of heart is the 'posterior' part.
Overall, it's the most posterior part of the wall in contact with the diaphragm.
That's segment 4 in the bull's-eye representation of the heart. (?used in CT)
bullsEyeRepresentationHeart.png

What artery is inolved? See table above.

ECG changes in posterior MI

posteriorStemi.png
Source

ECG-posterior-infarction-in-V2.jpg.webp
Posterior-leads-V7-V8-V9-ECG-placement.jpg.webp

Post MI prognosis

Killip class Features 30 day mortality
I No clinical signs heart failure 6%
II Lung crackles, S3 17%
III Frank pulmonary oedema 38%
IV Cardiogenic shock 81%

++ /dev/null


ECG features of myocardial ischemia

Source

  1. ST elevation (>1mm)
  2. ST depression - does not localise.
    1. ST depression confined to a single territory is likely to be reciprocal ST dips of an "opposite" ST elevation.
  3. T inversion if
    1. At least 1 mm deep
    2. Present in ≥ 2 continuous leads that have dominant R waves (R/S ratio > 1)
    3. Dynamic — not present on old ECG or changing over time
  4. Wellen's T waves

Features considered non specific for ischemia:
1. ST depression < 0.5 mm
2. T wave inversion < 1 mm
3. T wave flattening
4. Upsloping ST depression

STEMI diagnostic criteria

Source
Screenshot_20240821-215215.png

De Winter T wave

Type 2 Myocardial Infarction

[!INFO] Definition of type 2 MI:
Myocardial infarction: Myocardial damage that occurs due to ischemia.

Both must be differentiated from non-ischemic myocardial injury - i.e not an infarction.

[!INFO] Clinically distinguishing between Type 1 and Type 2 MI
The gold standard to distinguish between the two would theoretically be coronary angiography. However, in reality, it's a clinical judgement.
Type1VsType2MIProbabilityAndManagement.png

Presentation of type 2 MI

Management of Type 2 MI

Management: See the image above.

Posterior myocardial infarction (MI)

#2021GM-JUL/Q21

Which part of the heart is 'posterior'?

Source
This article confirms that there is some confusion about which part of heart is the 'posterior' part.
Overall, it's the most posterior part of the wall in contact with the diaphragm.
That's segment 4 in the bull's-eye representation of the heart. (?used in CT)
bullsEyeRepresentationHeart.png

What artery is inolved? See table above.

ECG changes in posterior MI

posteriorStemi.png
Source

ECG-posterior-infarction-in-V2.jpg.webp
Posterior-leads-V7-V8-V9-ECG-placement.jpg.webp

Post MI prognosis

Killip class Features 30 day mortality
I No clinical signs heart failure 6%
II Lung crackles, S3 17%
III Frank pulmonary oedema 38%
IV Cardiogenic shock 81%

Treatment
Based in TSH level.




pathogenesis of sciatica


- Beta blockers:  **propranolol** - given as first line locally, metoprolol (!? Even though it's cardioselective),

[[Myocardial infarction]]


Management of asthma:

Acute management of exacerbations

AsthmaExacerbationSuggestedAlgorithm.png
Source
See Source

[!INFO] Place for MgSO4
My initial question was whether MgSO4 is effective and safe and when it's use should be considered; At least in paediatrics, it's safe, effective, cheap and should be considered as first line parenteral therapy when initial management (with nebulisation) has failed. Use in preference to IV salbutamol infusion.
It works by multiple mechanisms including relaxing smooth muscle by blocking Ca entry and suppressing inflammation by 'stabilizing' immune cells.
Source

Asthma Vs. COPD

  1. How to distinguish the two?
  2. What are the significant differences in management?

[!INFO] Hypercapnia in asthma exacerbation is an alarming sign
Normally, there should be respriatory alkalosis;
Source

Source (2003 Article)

long term management

Goals of management


[!INFO] MPA and GPA are difficult to differentiate clinically
Because the staining patterns overlap
Source - lecture


https://careers.peninsulahealth.org.au/job/2024-PGY3%2B-Mid-Year-General-Stream-HMO/870-en_GB/
https://careers.peninsulahealth.org.au/job/2024-PGY3%2B-Mid-Year-General-Stream-HMO/870-en_GB/


MMRC

MMRCscoreForDyspnoea.png